People with cancer or HIV could lose Medicaid under new work rules, advocates say

Dr. Mehmet Oz, who leads the Centers for Medicare and Medicaid Services, explained the new work rules coming to Medicaid on Tuesday in the White House briefing room. Julia Demaree Nikhinson/AP hide caption

Advocates for people with serious illnesses, like cancer and HIV, say the strict Medicaid work rules that the Trump administration released this week are likely to put ongoing treatments in jeopardy.

States must put the work requirements into effect by January 1. That was already a tight timeline, says Adrianna McIntyre , assistant professor of health policy at the Harvard T.H. Chan School of Public Health.

"It takes states literally months — usually years — to make the types of changes to their systems that they needed to make for this new rule," she says. "They were severely constrained by the timeline having a year and a half from the time of the law being passed to implement all of this."

At stake is health coverage for 68 million low-income Americans on Medicaid, the health insurance system jointly funded by states and the federal government.

States must "make the changes, test the changes to make sure they're not going to break the system, and then go live," McIntyre says.

The nearly 400-page interim final rule released Monday makes that process even harder. For months, federal officials have been meeting with states informally and giving them guidance, and states understood that people with conditions where continuous health insurance coverage was really important would be exempt.

"What the rule says, as published, is that that's actually not enough," McIntyre explains. "The condition or the disease needs to be actively interfering with your ability to work. So people with early stage cancer who are in radiation treatment but still have the capacity to work, or people who have HIV but can still technically work, are not exempted from the work requirement."